Practical management of oliguria and impending ARF

The general principles of the management of oliguria are to exclude urinary tract obstruction and restore normal intravascular volume, adequate cardiac output, and blood pressure. This treatment is supplemented by the use of low-dose dopamine and diuretics. The efficacy of such an approach is variable and is determined by premorbid renal function, the size and duration of the insult, and the period that has elapsed without restorative therapy.

It is important to note that, although urine output is the most commonly used bedside monitor of renal performance, an increase in urine output does not necessarily imply an improved glomerular filtration rate. For example, low-dose dobutamine has been demonstrated to increase glomerular filtration rate but not urine output, while low-dose dopamine increased urine output but not glomerular filtration rate in hemodynamically stable critically ill patients ( Duke..et..a/ 1994).

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